POS0323 INDIVIDUALS AT RISK FOR RHEUMATOID ARTHRITIS – SELF MONITORING OF SYMPTOMS USING A DIGITAL APPLICATION ENABLES IDENTIFICATION OF HIGH RISK PATIENTS - RESULTS FROM THE PROSPECTIVE REMTORA TRIAL
Authors: N. Pfeuffer, J. Knitza, M. Grahammer, D. Simon, F. Hartmann, L. Schuster, K. Tascilar, G. Krönke, G. Schett, A. Kleyer
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Individuals at risk for rheumatoid Arthritis (RA) typically describe diffuse, fluctuating and flare-like symptoms followed by symptom-free periods. In this pre-disease continuum preplanned physical visits reveal only a fraction of symptoms and rudimentarily capture the burden of disease. Implementation of a smartphone-based patient self-monitoring approach could help to characterize the burden of pre-stage disease and enable a timely start of therapy. (1,2) <h3>Objectives</h3> The aim of this study is to evaluate the implementation of a smartphone-based remote patient self-monitoring application in patients in the prodromal phase of RA and to create a predictive tool for the distinction of high-risk and low-risk patients. <h3>Methods</h3> Individuals at risk for RA fulfilling the following inclusion criteria were recruited in a prospective 6-month trial: Proof of anti-citrullinated peptide antibodies (ACPA), no clinically detectable synovial swelling at doctors visit, smartphone ownership. Participants were recruited from a prospective at-risk cohort and provided written consent (ethics-approval: 333_16B and 21_21B). All individuals were presented two standardized, self-produced educational videos about joint self-examination and pre-clinical RA and were informed about the remote monitoring option, using the CE-certified ABATON app. A new adaptive questionnaire-based algorithm “REMOTRA; REMote moniToring in pReclinical Arthritis” was developed including typical RA symptoms such as pain, swelling, morning stiffness and intake of pain medication. The criteria are weighted and added to a quantitative score from 0 to 15 pts. A cut-off value from 10 or more was defined as being highly symptomatic. The total number of questions varies depending on the answers given. Questionnaire frequency was based on shared-decision-making (every 7, 14 or 30 days). App usability and acceptance was measured using the System Usability Scale (SUS) and Net Promoter Score (NPS). Routine clinical visits were scheduled on a regular basis every 3 months. <h3>Results</h3> 79 patients were approached and 43 patients consented to participate (13 male; mean age: 49.3; 7-day/14-day/30-day interval: 3/15/25). Three patients (7%) developed RA during the six months of study follow-up. Patient acceptance of the questionnaire decreased during the trial, from an NPS of 21.8 (47.8% promoters) at 3 months down to 8.3 (45.8% promoters) at six months. The education videos were well accepted with an NPS of 31.6 (joint self-examination; 57.9% promoters) and 54.4 (Pre-RA; 63.6% promoters). Questionnaire usability was continuously rated as high with an average SUS of 88.1/100 (SD: 5,5) at three months and 85.4/100 (SD: 16.0) at six months. The most frequently reported symptoms were joint pain (78.0%, n=32), followed by joint swelling (73.2%, n=30) and morning stiffness (43.9%, n=18). 58.5% (n=24) took analgesics and 29.3% (n=12) took prednisolone at least once. Seven patients (16.3%) reported no symptoms during the six months. None of the patients with a REMOTRA -Score &lt;10 developed RA (negative predictive value: 100%). However, patients with a score of 10 or more were diagnosed with a RA in their next consultation with a probability of 12% (positive predictive value). Monitoring adherence was high with a mean of 4.6 (SD: 2.0) months app usage and 57.1% completing all questionnaires. <h3>Conclusion</h3> Our study shows that individuals at-risk for RA appreciate standardized digital disease education and mostly adhere to a telemedicine monitoring program. Remote self-monitoring sheds light on disease progress of at-risk patients. Further development and testing of this method may be worthwhile for a better informed and efficient utilization of limited in-person visit slots. <h3>References</h3> [1]van Nies JAB, et al.: Ann Rheum Dis. 2014 May;73(5):861-70. doi: 10.1136/annrheumdis-2012-203130. [2]J. Knitza, et al.: JMIR Mhealth Uhealth. 2020 Aug 12;8(8):e19661. doi: 10.2196/19661. <h3>Acknowledgements</h3> We would like to thank Michaela Reiser for technical support. This study was supported by the Deutsche Forschungsgemeinschaft (DFG) PANDORA FOR2886 <h3>Disclosure of Interests</h3> Nicola Pfeuffer: None declared, Johannes Knitza Consultant of: consulting work for Abaton GmbH, Manuel Grahammer: None declared, David Simon: None declared, Fabian Hartmann: None declared, Louis Schuster: None declared, Koray Tascilar: None declared, Gerhard Krönke: None declared, Georg Schett: None declared, Arnd Kleyer: None declared.